多层螺旋CT:评估心肌活性

Evaluation of myocardial viability in myocardial infarction by multi-slice computed tomography

心肌梗死后心肌活性的诊断是为了评估患者心肌坏死的范围以及进行血运重建后梗死心肌功能恢复的可能性。MR作为心肌活性的诊断方法,日臻完善,最新的研究表明,由于时间和空间分辨率的不断提高,MR技术已成为评价心肌活性的重要方法之一,并已经应用到临床实践之中。近年来多层螺旋CT(MSCT)技术的迅速发展,使得评估心肌活性成为可能。首过灌注显示微血管阻塞,延迟增强可直接显示坏死心肌和瘢痕组织。通过判断坏死心肌延迟增强后的透壁程度,能够提供有关患者心肌活性及预后的信息。多层螺旋CT不仅能够全面提供心肌梗死后心脏解剖、形态及功能综合评价的信息,而且可能提供心肌灌注和心肌活性等信息,因此MSCT在不久的将来可能作为一种极具有潜力的评价心肌活性的方法之一。

Improving the ability to distinguish dysfunctional but viable myocardium from nonviable tissue after acute or chronic ischemia has important implications for the therapeutic management of patients with coronary artery disease. Assessment of myocardial viability and infarct morphology with delayed contrast-enhanced MRI has been well validated over the past several years and is performed routinely by several clinical cardiac MRI centers. The recent advent of multi-slice computed tomography （MSCT） technology has greatly improved spatial and temporal resolution and has expanded its potential for a more comprehensive evaluation of cardiovascular diseases. In first pass phase hypo-enhanced regions showed micro-vascular obstruction and in delay phase late hyper-enhanced regions showed myocardial necrosis and chronic scar. Combined with coronary artery CTA, MSCT can provide more information besides morphology of coronary artery in assessing cardiovascular disease.